Wednesday, 8 February 2017

In November, when with a friend on our way back from seeing someone depart for Paradise by way of Kensal Green, I tripped and fell on a railway platform and sustained a fracture to my left arm, at the upper end of the humerus. This must rank very low on the scale of injuries requiring hospital treatment, and indeed the orthopaedic surgeon who first looked at it chose to put the arm in a sling and let it heal, rather than resorting to surgery. But the injury was still enough to provoke a few thoughts, which I record here.

Before doing so, however, I would like to record my very great thanks to everyone who helped, both friends and transport and medical staff. Among the latter I number (in order of encounter):

1. the platform staff at Oxford Circus station. They were with me within 30 seconds of my falling, and made sure I was alright and able to continue safely (in the company of the friend who was with me) to where I could get medical help;

2. the pharmacist at Boots on Kingsway whom I first approached in search of a sling and painkillers, who told me that there might be a fracture and sent me to hospital;

3. the Accident and Emergency and Urgent Treatment Centre staff at University College Hospital. I was passed smoothly round the necessary doctors, orthopaedic surgeon, nurses and radiographers, and while work in such departments must be stressful, they were at all times calm and friendly;

4. the staff of the Fracture Clinic at the same hospital, which I visited three times from December up to early February. Again, orthopaedic surgeons, nurses, radiographers and administrative staff ran the operation very smoothly;

5. the radiographer and the orthopaedic surgeon who took a look to make sure there was no displacement when I was in Hong Kong for a while in December;

6. the physiotherapist whose clinic at University College Hospital I now attend, and probably will attend for a little while to come. Each time I go I get a friendly and efficient review of progress, and am sent away with clear instructions as to which exercises to practise.

The National Health Service sometimes gets a bad press. This has been by far my most significant encounter with the Service to date, and I want to say out loud that they have been absolutely superb. The next time you read a story saying that they have got something wrong, please bear in mind that they get things right thousands of times a day, and the newspapers hardly ever notice.

Now to the thoughts provoked by the fracture. None of them is original, but some of them only come to mind in abnormal circumstances.

1. What happens is so contingent on trivial details. If I had stepped off the train a little bit differently, my course might have been to one side of where it was, or my feet might have fallen at each pace a few centimetres behind where they in fact fell, and the trip might have been avoided. As a corollary to this, there was no practical way to see the risk coming. Even approximations to the predictive power of Laplace's demon are unavailable.

2. Following on from this first thought, trivial differences can make a big difference to the next few months. My reading and writing were interrupted and then slowed down, and a couple of talks I was due to give had to be cancelled. (A trip to Hong Kong and Singapore, on the other hand, starting ten days after the accident, went ahead, although I don't think the orthopaedic surgeon in the London fracture clinic was very happy about that.) But the effects need not be life-changing. My life is now back to what it probably would have been if the fracture had not occurred. Of course something life-changing might have happened at the talks, had I given them, but that is mere speculation, and the possibility is too ill-specified for there to be any fact of the matter about whether something life-changing would have happened. (For comparison, I buy a lucky dip lottery ticket for each Saturday's draw, but given that the numbers are generated randomly and depend on the shop one uses and the precise time of purchase, there is no fact of the matter as to whether, when I happen to miss a Saturday, I would have won had I bought a ticket.)

3. It is sometimes said that one should get on and do the important things in life, because one might for all one knows die quite soon. This argument is less persuasive than it used to be, at least when addressed to people who are young or in middle age, because while there are early deaths, the probability of dying when young or in middle age is much lower than it used to be. We should perhaps replace the argument with one which turns on the fact that one might lose some important abilities relatively early in life. My fracture is healing nicely, but I could easily have suffered a permanent injury. And in a world that is structured around people with four fully functioning limbs, good eyesight, and so on, moderate injuries can impose significant limitations, despite provision being made for the disabled. To take a trivial example, when one arm is out of action or cannot be used to apply any significant force, it takes much longer than normal to get dressed, and you have to find someone else to do up your shoelaces.

4. It is remarkable how little one notices about one's body until something goes wrong. The big lesson for me was that no body part is an island. Everything is connected under the skin. Thus for the first week, any movement of the upper left arm was painful. So I took care to do everything with the right arm. But certain movements of the right arm led to pain in the left arm. And if I had to pick something up from the floor, crouching down (moving only the legs, not the arms) also led to pain in the left arm.